Endoscopic sphincterotomy (ES) has been shown to be an effective treat- ment for relieving biliary-type pain in patients with sphincter of Oddi dysfuntion defined by elevated baseline sphincter pressures at the time of endoscopic retrograde cholangiography (ERC). Recent studies suggest that sphincter of Oddi manometry is neither 100% sensitive nor specific in predicting response to ES; further the efficacy of ES in patients with clinical sphincter dysfunction and normal manometry is largely unstudied. We theorize that endoscopic sphincterotomy will result in significant pain alleviation and improved quality of life when compared to sham sphincterotomy in this previously unstudied patient population.